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Robotic Surgery Ideal for Certain Pediatric Urology Conditions

New York(Apr 15, 2009)

The Division of Pediatric Urology at Morgan Stanley Children's Hospital has expanded the use of robotic surgery and today routinely uses this approach to treat urological conditions in children, from infants to 18 years and older. Robotic surgery – an improved type of laparoscopic, minimally invasive surgery pioneered in adults, has been found to be ideally suited for certain conditions in children such as ureteropelvic junction (UPJ) obstruction, in which a small segment that transports urine out of the kidney becomes blocked.

About Robotic Surgery

While robotic surgery is not appropriate for every procedure, it is particularly helpful for operating on parts of the body that are difficult to access without making a large incision. During robotic surgery, the surgeon uses the assistance of a robot to operate on the patient through tiny holes (or ports) in the body instead of a large open incision. Robotic technology consists of a surgeon's console that controls a tower with four working arms. One arm controls the three-dimensional camera's movements inside the body, while the remaining three arms hold specialized laparoscopic instruments. The robotic arms precisely replicate the surgeon's hand and finger movements from the console.

At the start of the robotic surgery, miniature instruments are introduced into the body by the surgeon via small tubes, eliminating the need for larger incisions. During robotic surgery, the surgeon sits at a console where he can manipulate the miniature instruments. The end of the instrument has three different hinges that allow the surgeon to rotate, spin, and move the instrument in any direction. The surgeon is able to control the instruments as nimbly as he or she would with their own fingers and wrists and in an intuitive fashion. The robot can only respond to the surgeon's movements and motions, and it is incapable of moving on its own, thereby ensuring safe outcomes.

Benefits of Robotic Surgery

Robotic surgery benefits patients in a number of ways, including:

Less pain

Less blood loss

Fewer complications

Less scarring

Shorter hospital stay

A quicker recuperation also allows patients – and their families – to return to their normal activities sooner.

"The advantage of robotic surgery, even over the standard laparoscopy, is that it really allows you to do things very precisely, more elegantly and in an easier fashion," said Richard N. Schlussel, MD, FAAP, FACS. "The visualization is greater – it's three dimensional as opposed to two dimensional – with greater magnification."

At Morgan Stanley Children's Hospital, under the leadership of Dr. Schlussel, an experienced team of pediatric urologists, anesthesiologists, nurses, and technicians are specially trained in robotic surgery.

In children, robotic surgery is commonly used in a procedure called pyeloplasty for ureteropelvic junction (UPJ) obstruction. In this condition, a blockage prevents the flow of urine from the kidney, down the ureter and into the bladder, causing the urine to build up. Through robotic surgery, pediatric urologists can remove that segment and reconnect the ureter to the kidney with sutures. This procedure requires several very precise maneuvers for which the robot is well suited.

"We are also using robotic procedures in children as young as 12 months to remove all or part of a kidney, to remove a kidney and ureter, and to reimplant a ureter," says Dr. Schlussel. "We have also performed reconstructive procedures in children with spina bifida to reconstruct their appendix and their bladder."

According to Dr. Schlussel, another advantage of robotic surgery is the elimination of a scar that would result from traditional surgery. "Just like a child's legs and arms are going to grow as they get older, so will that "tiny scar" they had as an infant. These scars tend to become quite large in adulthood."

Dr. Schlussel also stresses the safety of robotic surgery. "The safety of children is really our first concern, and it's been demonstrated here and at institutions around the country that robotic surgery is very safe."

Faculty Contributing to this Article:

Richard N. Schlussel, MD, FAAP, FACS is the Director of Pediatric Robotic Surgery at the Morgan Stanley Children's Hospital, and an Assistant Professor of Urology at Columbia University College of Physicians and Surgeons.